Alec's Law - T1International

After Alec died, Nicole Smith-Holt, her family, and T1International’s Minnesota #insulin4all Chapter began a years-long fight that culminated in the passage of Alec’s Bill in 2020. Alec’s Law is a package of reforms intended to ensure that no person who relies on injected insulin to stay healthy or live will have to forgo taking their medicine because of cost. The advocacy of Smith-Holt and other #insulin4all advocates have inspired legislators from all over the country to express interest in introducing similar legislation at the state and federal level.

The insulin safety net program established in Minnesota through Alec’s Bill works as follows:

The patient seeking an emergency supply of insulin has to complete a form attesting that they meet the following eligibility requirements:
- A current resident of Minnesota
- Not currently enrolled in Medicaid
- Does not have insurance that covers insulin for $75 or less out of pocket
- Has not received an emergency supply of insulin in the last 12 months.
The patient must bring the form to a pharmacy, a valid insulin prescription, and a valid Minnesota state ID. If the patient is under 18, their parent provides proof of residency.
The pharmacist then provides the patient with a 30-day supply of insulin for a co-pay of no more than $35, as well as information on ongoing support to help the patient acquire the insulin they need. Additionally, the pharmacist alerts the health care practitioner who issued the prescription within 72 hours of dispensing it.
After providing the patient with their insulin, the pharmacy submits a request to the insulin manufacturer to either reimburse them for the remaining cost of the insulin after the patient’s co-pay or provide the pharmacy with a replacement supply of the same insulin at no cost to the pharmacy.

The law also includes longer-term continuing need provisions, including:

Establishing a new training program for navigators to provide them with information and resources to help people in accessing appropriate long-term insulin options.
Requiring manufacturers to expand patient assistance programs to cover more people with low incomes by providing a 90-day supply of insulin for no more than $50 from their pharmacy.
In the event that a person doesn’t qualify for the manufacturer assistance program, they can get insulin through the state’s continuing safety net program. They would receive a 90-day supply for the same $50 co-pay. Minnesotans can take advantage of this provision every 90 days, but have to reapply to the insulin safety net program every year.

More than 1,100 Minnesota residents used the insulin safety net program to secure insulin in 2021.

Alec’s Story

Alec Raeshawn Smith was diagnosed with type 1 diabetes in May 2015, at age 24. Under provisions of the Affordable Care Act, Alec was able to maintain his health insurance coverage under his mother’s plan for the first two years after his diagnosis. However, soon after he aged off of his mother’s insurance plan when he turned 26 on May 20, 2017, he started struggling to afford his insulin. Alec was a restaurant manager earning just over $2,000 per month. His monthly costs for insulin and supplies were roughly $1,300. With no way of acquiring health insurance that he could afford, Alec tried to stretch what was left of his insulin until his next payday on June 30 by rationing his doses.

On June 27th, 2017, Alec’s girlfriend found him in his apartment, deceased. His official cause of death was diabetic ketoacidosis. His mother, Nicole Smith-Holt, said at the Eli Lilly shareholder meeting in May 2018, “the unofficial cause of death is slipping through the cracks of our broken health care system and corporate greed.”

States that Have Passed Alec’s Law

Due to the high price of insulin, many people are unable to afford the cost of refilling their prescription as often as they need to at the pharmacy counter. A 2020 T1International survey found that 1 in 4 people with type 1 diabetes in the United States rationed their insulin at some point in the past year.

The following states have passed their own version of Alec's Law:

Minnesota - Up to $35 for a 30 day supply once per a twelve month period. A fine for insulin manufacturers who fail to comply of $200,000
Colorado - Up to $50 for a 30 day supply once per a twelve month period. A fine for insulin manufacturers who fail to comply of $10,000 per month
Maine - Up to $35 for a 30 day supply once per a twelve month period. A “civil penalty” for insulin manufacturers who fail to comply.

Utah - Labeled as an “Insulin Discount Program” for eligible Utah residents who are uninsured or have a “high-deductible” plan. Covers specific insulin “brands” at a non-fixed rate.